Surgical instrument



Jan. 29, 1963 F. ROSE ETAL SURGICAL INSTRUMENT 3 Sheets-Sheet 1 FiledNov. 2, 1960 FRANK L. ROSE MAURICE H. SUBILIA INVENTORS Jan. 29, 1963 F.ROSE ETAL SURGICAL INSTRUMENT 3 Sheets-Sheet 2 Filed Nov. 2, 1960 FRANKROSE MAURICE H. SUBILIA INVENTORS BY m j ATTORNEY Jan. 29, 1963 F. L.ROSE ETAL 7 3,075,199

SURGICAL INSTRUMENT Filed Nov. 2, 1960 3 Sheets-Sheet 3 FRANK L. ROSEMAURICE H. SUBILIA INVENTORS BY 64, /i ?ORNEYS 3,d-75,i33 Patented r n.as, less 3,375,139 SURGICAL KNSTRUMENT Frank L. Rose, Lawrence, Mass,and Maurice H. Suhiiia, Salem Depot, N.H., assignors to AvcoCorporation, Cincinnati, (ihio, a corporation of Delaware Filed Nov. 2,1956, Ser. No. 66,779 17 illainis. ((31. 1-349) This application relatesto surgical instruments and, in particular, to a semi-automaticdispenser of surgical clips. In many surgical procedures, metal surgicalclips or ligatures have replaced skin sutures in closing wounds orincisions made in the skin during major surgery. The surgical clips usedtoday come in several shapes and forms. The most popular form iscommonly referred to as a spur type clip, and it is fully described inthe Schulman Patent 2,232,142. It will be noted that this form ofsurgical clip contains a pair of outwardly extending tabs which areseparated when the clip is applied to a wound. See FIGURES 3 and 6 inthe Schulman patent. This form of clip is popular because it can beremoved by merely bringing the tabs together with a forceps. In sodoing, the prongs of the clip are removed from the skin.

Currently, these spur clips are applied by hand one at a time and theprocess is quite time consuming. The existence of the tabswhich isprecisely why these clips are so popular-has heretofore, made itdifficult to design a practical semi-automatic dispenser.

It is an object of this invention to provide a semiautomatic surgicalclip dispenser which:

(1) Dispenses spur type surgical clips.

(2) Holds and dispenses surgical clips, one at a time, with a minimum ofdelay.

(3) Includes indexing means for automatically feeding one surgical clipat a time to a dispensing position.

(4) Includes a surgical clip holder that can be easily removed from thedispenser and is of such a nature that it may be disposed of in favor of'a replacement holder.

(5) Dispenses and indexes in a single actuation.

(6) Accommodates many forms and sizes of clips used in surgicalprocedures by means of easily interchangeable clip holders.

(7) Is simply constructed, inexpensive to manufacture, has a minimum ofmoving parts, is easily operated with a finger and thumb of one hand, iscompact, and pleasant in appearance.

In accordance with the invention, the surgical clip dispenser forapplying surgical clips to a wound, comprises a clip holder rotatablymounted within the dispenser. The clip holder includes spaced means forengaging and holding surgical clips. The surgical clip dispenser also includes a housing including means for releasably engaging the clipholder. Actuating means for dispensing a surgical clip and applying thedispensed surgical clip to a wound is also provided. The surgical clipdispenser also includes indexing means cooperating with theaforementioned actuating means for bringing surgical clips to adispensing position, one at a time.

The novel features that we consider characteristic of the invention areset forth in the appended claims; the invention itself, however, both asto. its organization and method of operation, together with additionalobjects and advantages thereof, will best be understood from thefollowing description of a specific embodiment when read in conjunctionwith the accompanying drawings, in which:

FIGURE 1 is an exploded representation of a surgical clip dispenserembodying the principles of the present invention;

FIGURE 2 is a side view of the FIGURE 1 surgical clip dispenser;

FIGURE 3 is a sectional view taken along line 3-3 of FIGURE 2;

FIGURE 4 is a top view of the FIGURE 1 dispenser with its cover opened;

FIGURE 5 shows one side of a disc used to engage and hold surgicalclips;

FIGURE 6 is a sectional view taken along line 6-6 in FIGURE 5;

FIGURE 7 is a fragmentary top view showing details of the indexingmeans; and

FIGURE 8 is a second top the indexing means cedure. I

Referring to FIGURES 1 2, and 4, in particular, there is represented asurgical clip dispenser 10 embodying the principles of the presentinvention. The surgical clip dispenser It comprises a housing 11 whichincludes an arcuate portion 12 and a rectangular extension 13. Thearcuate portion 12 includes two perpendicular openings identified forpurposes of this application as the vertical opening 14 and thehorizontal opening 16. See FIGURE fragmentary view showing partiallythrough an indexing pro- The extension 13 is box-like in constructionand extends from the arcuate portion 12 with its top surface 15 in theplane of the horizontal openingld.

As seen in FIGURES 1 and 2, a spring assembly comprising a spring 17 anda restraining element 18 fits within a compartment 19 defined by thewalls of the extension 13. The restraining element 18 abuts against apair of stops 21 located at the junction of the extension 13 andthe'horizontal opening 16. The spring assembly is retained within theextension 13 by a screw 22 which passes through a clearance hole 23 andis threaded into a complementary'threaded hole 24 at the free end of theex- .tension 13. I

A pairof L-shaped rails 26 and 27 are secured horizontally, as bysoldering, to the inside surfaces of the arcuate portion 12. See FIGURES1 and 3. The horizontal surfaces 28 and 29 of the rails 26 and 27,respectively, are in the same plane with an inside surface 30 of theextension 13. The vertical legs 31 and 32 of the rails 26 and 27,respectively, extend toward the marginal edges defining the horizontalopening 16, but fall short of this edge by a small amount. See FIGURE 1.

A pair of stops 33 and 34 are secured to the rails 26 and 27 at thejunction of thevertical opening 14 and the horizontal opening 16. Thestops 3-3 and 34 are preferably rectangular and stop 34 extendsoutwardly from rail 27. See FIGURE 4.

The surgical clip dispenser 10 also includes a cover 36 which is pivotlymounted to the extension 13 by means of a'hinge 37 (FIGURES 1 and 4)comprising hinge pertions 37:: on the extension 13, 37b on the cover 36,and pin 370.

The cover 36 is generally U-shaped and includes arms 38 and 39 joined atone end by a bight 41. The spacing between the arms 38 and 39 isenlarged adjacent to the bight 41 in order to provide adequate clearancefor the surgical clips to pass through, as will be shown hereinafter.The arm 39 includes 21 depending latch 42 which is adapted to engage thestop 34 and rail 27 and secure the cover 36 to the arcuate portion 12 ofthe housing 11.

The arm 39 also includes a slot 43 on the forward outer edge. The slot43 is provided to accommodate a bracket 44, which is secured therein inany convenient manner such as soldering. A depression 45, also on arm39, is provided for clearance for a housing 71 on an indexing means, tobe described.

The surgical clip dispenser 19 also includes a disc assembly 46comprising a disc 47 rotatably mounted to a disc holder 48. The discholder 48 is shaped generally in the form of a U having arms 49 and 51separated just enough to allow the disc '47 to rotate therebetween. Thedisc holder 48 also includes an enlarged separation disc 46, asrepresented by the pin 52. Disc 47 comprises a hub 53 (FIGURE 3) with aring 54 extending outwardly from the hub 53. One side 56 of the hub,shown in FIGURE 5, includes a circular configuration of equally spaceddepressions 57. These depressions 57 coact with the projection 50 toform a simple detent mechanism for positioning the disc.

The second side 58. of the hub 53 comprises a series of radiallyextending spaced teeth 59 which terminate at the interior edge of thering 54. The teeth 59 comprise a transverse surface 61 extendingoutwardly and perpendicular to the plane of the disc 47, and a slopingsurface 62 inclining inwardly in a counterclockwise direction from thetransverse surface 61. It will be noted, in FIGURE 1 particularly, thatthere is a space 63 between adjacent teeth 59. There are an equal numberof teeth 59 and depressions 57. V

As seen in FIGURES 3 and 5, the annular ring 54 comprises a relativelythin cross section and includes spaced slots 64 formed by a periodicreduction in the thickness of the annular ring 54. The radial length ofslots 64 is smaller than the width of ring 54, forming recesses 60. SeeFIGURE 5.

It will be noted that the annular ring 54 extends partially into theenlarged separation between arms 49 and 51 adjacent to the bight 55 ofthe disc holder 48. Surgical clips 65, as see in FIGURES 1 and 2, extenda short distance beyond the end of the annular ring 54 and, therefore,also pass through the aforementioned enlarged separation. Theaforementioned enlarged separation adjacent to bight 41 in the cover 36is also provided for clearance.

' The disc assembly 46 is inserted into the dispenser by placing thedisc holder 48 on the horizontal surfaces 28 and 29 of the rails 26 and27, respectively, between the stops 33 and 34 and stops 21. It will benoted in FIGURE 2 that the bight 55 engages the restraining element 18on the spring 17 and partially depresses the spring 17. It will also benoted that the width of the bight is reduced (FIGURE 1) to clear thestops 21, when the disc assembly is moved towards the rear against thespring 17.

Referring to FIGURE 5, there is depicted a surgical clip 65 mounted toring 54. It will be noted that the slots 64 are inserted in thespacebetween tabs 66 (FIG- URE 4) and secured thereby. A portion of the clipis seated in the recess 60 to further prevent movement of the clips 65out of the slots 64.

The surgical clip dispenser 10 also includes indexing means whichrotates the disc 47 to feed one surgical clip 65 at a time into adispensing position. As will be seen hereinafter, a surgical clip 65 isdispensed and indexed in a single actuation of the surgical clipdispenser 10. The indexing means comprises the teeth 59 and a fingerassembly 68, best seen in FIGURES 1 and 3, which includes spring loadedfinger 69 extending through housing 71 and terminating in an eniargedhead 72 for manual manipulation. The free end 73 of the finger 69 ischamfered so that a sloping surface 74 (FIGURES 1, 7 and 8), which isparallel to the sloping surface 62 of the teeth 59, is developed.

The finger 69 fits into sleeve 71a and a spring 7115 is slid over it.The finger 69 and spring 71b are secured in the sleeve 71a by means of awasher 71c being inserted in a slot 71d adjacent to the free end offinger 69. Sleeve 71a is then secured to housing 71 by solder or othersuitable means. through bracket 44 and is secured thereto by nut 71c,

The housing is then inserted Normally, the free end 73 sits in the space63 (FIG- URES 7 and 8) between adjacent teeth 59. When the disc assembly46 is moved to the rear, along the rails 26 and 27, the sloping surface74 of finger 69 slides over the sloping surface 62 into the nextclockwise space 63. See FIGURE 8. When the disc assembly 46 is permittedto move forward, the force of the free end 73 of the finger 69 againstthe transverse surface 61 causes the disc to rotate counterclockwise andthereby carry a clip into a dispensing position. It is obvious that theangular spacing between depressions 57 on the side 56 of the disc 46 isequal to the angular separation between spaces 63 bracketing a tooth 59.The action of the projection 50 in a depression 57 prevents unintendedrotation of the disc 47.

The actuating means of the surgical clip dispenser 10 comprises a pairof leaf spring actuators 76 and 77 secured at one end to the sides ofthe extension 13 shown in FIGURES l and 4. The actuators 76 and 77 areterminated at their free ends by a pair of inwardly extending jaws 78and 79 which, in turn, are terminated in concave surfaces 81 and 82respectively. The concave surfaces 81 and 82 engage and hold a surgicalclip 65 during the time that the clip is being applied to a wound anddispensed from the surgical clip dispenser 10. See FiGURE 4. I

The act of applying a surgical clip to a wound involves simply pressingthe actuators 76 and 77 towardeach other by means of a thumb and afinger of one hand. As the surgical clip begins to collapse, and bend,under the pressure of the actuator, the collapse of surgical clip 65causes the tabs 66 to move against the disc 47 causing the disc assembly46 to move against the action of spring 17 into compartment 19 of theextension 13. After the clip 65 has been applied to the wound andpressure released from the actuators 76 and 77, the disc assembly 46moves forward toward the jaws 73 and 79 and, in the manner describedheretofore, indexes and feeds a new clip into position between the jaws78 and 79.

It will be noted that actuator 77 includes a spring loaded pin assembly83. Referring to FIGURE 1, it is seen that pin assembly 83 comprises apin 83a which is normally seated in a sleeve 8311. A spring 83c isplaced on the pin 83a and secured in position by means of a cap 830!which is secured in any suitable way to sleeve 83a. The pin assembly 83is then inserted in hole of actuator 77 and secured thereto as bysoldering. The pin assembly is positioned adjacent to hole 84 in theadjacent wall of the arcuate portion 12.

When the actuators 76 and 77 have been moved toward each other to applyand dispense a surgical clip 65, and the disc assembly 46 has been movedrearwardly, the pin 83 extends into a slot 86 at the front of arm 51 ofdisc holder 48. See FIGURE 1. In this position it will not permit thedisc assembly 46 to move forward until the jaws 81 and 82 of theactuators 76 and 77 are spaced away from the dispensed surgical clip andare separated by a sufficient distance to provide adequate clearance forthe next clip being moved into a dispensing position.

Summarizing briefly the operation of the clip dispenser 19, clips aredispensed by merely depressing actuators 76 and 77. The indexing meansrespond to the release of the actuators 76 and 77 to move a new clipinto position to be dispensed. The rate at which clips are dispensed isdetermined by the user and can be quite high.

An important consideration in the present invention is the detachablemounting of the disc assembly 46 in the housing 11. It can be insertedor removed without disassembling the housing or loosening partstherefrom which are not intended to be loosened in the normal course ofoperating the surgical clip dispenser 10.

To load the surgical clip dispenser or to provide additional clips, itis merely necessary to raise cover 36, lift out disc assembly 46, inserta replacement on the rails 26 and 27, close the cover, and continue theclip procedure. Accordingly, for purposes of this invention the termdetachable mounting is defined as a mounting for an easily removable,replaceable or temporarily secured part.

The various features and advantages of the invention are thought to beclear from the foregoing description. Various other features andadvantages not specifically enumerated will undoubtedly occur to thoseversed in the art, as likewise will many variations and modifications ofthe preferred embodiment illustrated, all of which may be achievedwithout departing from the spirit and scope of the invention as definedby the following claims.

We claim:

1. A surgical clip dispenser for applying Surgical clips to a woundcomprising: a disc including spaced means for engaging and holdingsurgical clips; a housing including means for rotatably mounting saiddisc; a cover connected to said housing for detachably securing saiddisc in said housing; and means for dispensing a clip from said disc toa wound.

2. A surgical clip dispenser as described in claim 1 in which saidspaced means are located on the periphery of said disc.

3. A surgical clip dispenser for applying surgical clips to a woundcomprising: a disc including spaced means for engaging and holdingsurgical clips; a housing including means for rotatably mounting saiddisc; means, including indexing means for rotating said disc apredetermined amount; and means for dispensing a clip from said disc toa wound.

4. A surgical clip dispenser as described in claim 3 in which saidhousing also includes means for detachably mounting said disc to saidhousing.

5. A surgical clip dispenser for applying surgical clips to a woundcomprising: a disc including spaced means on periphery of the disc forengaging and holding surgical clips; a housing including means forrotatably mounting said disc; actuating means for dispensing a clip fromsaid disc to a wound when manipulated; and indexing means responsive tothe manipulation of said actuating means and said disc for rotating saiddisc a predetermined amount.

6. A surgical clip dispenser for applying clips to a Wound comprising:an assembly including a disc holder and a disc having spaced means forengaging and holding surgical clips mounted to the disc holder; ahousing for slidably mounting said assembly; actuating means adapted toengage a clip for dispensing said clip from the clip dispenser to awound and thereby sliding said assembly relative to said housing; andindexing means responsive to the sliding movement of said assembly forrotating the disc a predetermined amount.

7. A surgical clip dispenser as described in claim 6 in which saidhousing includes, in addition, means for detachably mounting saidassembly to said housing.

8. A surgical clip dispenser for applying surgical clips to a woundcomprising: an assembly including a disc holder, and a disc includingspaced means for engaging and holding surgical clips mounted to the discholder; a housing including means for slidably mounting said assembly;actuating means adapted to engage a clip for dispensing said clip andthereby reciprocating said assembly away from and toward said actuatingmeans; and indexing means responsive to the reciprocating movementoutside assembly for rotating the disc a predetermined arnount, wherebya new clip is carried to said actuating means.

9. A surgical clip dispenser as described in claim 8 which includes, inaddiuon, means tor preventing the disc from rotating until there isadequate clearance tor a succeeding clip at said actuating means.

10. A surgical clip dispenser as described in claim 8 which includesmeans for preventing an unintentional rotation of said disc.

11. A surgical clip dispenser as described in claim 10 in which saidlast mentioned means comprises spaced depressions on said disc and aprojection on said disc holder coacting with said depressions.

12. A surgical clip dispenser for applying surgical clips to a woundcomprising: a disc including spaced slots around the periphery thereoffor engaging and holding surgical clips, said disc including, on oneface thereof, equally spaced radially extending teeth; a means forrotatably mounting said disc, said disc and mounting means comprising anassembly; a housing including an opening and a pair of opposing railssecured adjacent to and parallel to the opening, said assembly beingadapted to seat on said rails and slide thereon; a cover pivotiy securedto said housing and providing adequate clearance for said disc beingadapted to detacnably mounting said assembly in said housing; a springloaded finger assembly positioned on said cover and adapted to engagesaid one side of said disc, the finger normally being seated betweenadjacent teeth adapted to slide over the teeth; actuating meanscomprising a pair of opposed arms adapted to bridge a surgical clipmounted to said disc and to dispense the clip by compressing it, therebyreciprocating said assembly on said rails whereby said finger slidesover a tooth into an adjacent slot and rotates said disc when saidactuating means is released.

13. A surgical clip holder assembly comprising: a disc having spacedmeans around its periphery for engaging and holding surgical clips; adisc holder for rotatably mounting said disc; and cooperating means onsaid disc holder and said disc for preventing unintentional rotation ofsaid disc.

14. A surgical clip holder assembly as described in claim 13 in whichsaid last mentioned means comprises a circular distribution ofdepressions on one face of said disc and a complementary projection onsaid disc holder.

15. A surgical clip holder assembly comprising: a disc having spacedslots, formed by periodically reducing the thickness of said discadjacent to its periphery for engaging and holding surgical clips; adisc holder comprising a U-shaped member having first and second armsjoined by a bight; and means interconnecting said disc and said discholder for rotatably mounting said disc between the first and secondarms.

16. A surgical clip holder assembly comprising: a disc having spacedradial slots around its periphery for engaging and holding surgicalclips; and a disc holder for rotatab-ly mounting said disc.

17. A surgical clip dispenser for applying surgical clips to a woundcomprising: a disc including spaced slots comprising areas of reducedthickness on the periphery of said disc for engaging and holdingsurgical clips; a housing including means for detachably and rotatablymounting said disc; and means for dispensing a clip from said disc to awound.

References Cited in the file of this patent UNITED STATES PATENTS1,880,569 Weis Qct. 4, 19,3;

1. A SURGICAL CLIP DISPENSER FOR APPLYING SURGICAL CLIPS TO A WOUNDCOMPRISING: A DISC INCLUDING SPACED MEANS FOR ENGAGING AND HOLDINGSURGICAL CLIPS; A HOUSING INCLUDING MEANS FOR ROTATABLY MOUNTING SAIDDISC; A COVER CONNECTED TO SAID HOUSING FOR DETACHABLY SECURING SAIDDISC IN SAID HOUSING; AND MEANS FOR DISPENSING A CLIP FROM SAID DISC TOA WOUND.